Phacoemulsification in the standing position with loupe magnification and headlamp illumination

A patient who could not recline from the seated position because of myotonic dystrophy and advanced interstitial lung disease presented to the UCLA Department of Ophthalmology Inpatient Consultation Service complaining of poor vision in both eyes as a result of corticosteroid-induced cataracts. We performed phacoemulsification and posterior chamber intraocular lens implantation in the standing position using magnifying loupes and fiber optic headlamp illumination. The excellent red reflex provided by the coaxial headlamp and the surgical control provided by bracing the operating hand against the cheek made this approach a viable option for this severely compromised patient. We discuss the surgical technique and its limitations.